Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome secondary to antimicrobial therapy in pediatric bone and joint infections

BACKGROUND: Bone and joint infections are common in children, particularly those under 10 years of age.

While antimicrobial therapy can often successfully treat these infections, surgical drainage may also be necessary.

It is important to note that prolonged courses of treatment have been associated with adverse events and drug reactions.

Among these, drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome is particularly severe and potentially life-threatening.

We aimed to evaluate the cases of DRESS syndrome that develop during the treatment of bone and joint infections.

METHODS: A retrospective study was conducted at a tertiary-level university hospital between 2015 and 2022 to determine the incidence and outcomes of definite DRESS Syndrome in children under 18 years of age with bone and joint infections.

RESULTS: Of 73 patients with bone and joint infections, 16 (21.9 %) children developed antimicrobial therapy-induced DRESS syndrome.

Eight (50 %) of these children were boys; the mean age of the patients was 9.76 ± 5.5 years.

DRESS syndrome occurred in 16 children, including 13 children with osteomyelitis, 1 child with osteomyelitis and septic arthritis, and 2 children with septic arthritis and sacroiliitis.

The mean duration of intravenous antibiotic therapy was 40.6 ± 16.6 days; the mean hospital stay was 48.7 ± 23.7 days; the mean time for the development of DRESS syndrome after starting antibiotics was 19.6 ± 7.68 days.

New onset fever (68.8 %) and rash (43.8 %) were the most common symptoms of DRESS Syndrome.

Cefotaxime and vancomycin were drugs responsible for DRESS syndrome in 8 (50 %) of 16.

The causative antibiotics were switched to another class of antibiotic, most commonly preferred was ciprofloxacin (n:5; 31.3 %).

For children with persistent symptoms, steroids were used in 5 (31.25) patients.

CONCLUSIONS: Clinicians should be aware of DRESS syndrome in children who develop fever and rash under long-term antibiotics and should check hematological and biochemical parameters to predict the severity of DRESS syndrome.

In patients with persistent symptoms, steroids may be used to control the symptoms.